Total Arterial Revascularization is Superior in Heart Failure Patients with Reduced Ejection Fraction—A Propensity Score Matched Retrospective Multicenter Analysis

Background: Ischemic cardiomyopathy (ICM), a leading cause of heart failure with reduced ejection fraction (HFrEF), presents significant treatment challenges. Total arterial revascularization (TAR) has emerged as a promising technique, offering potentially superior outcomes compared with traditional methods, particularly in severe ventricular dysfunction. However, the benefits of TAR following isolated coronary artery bypass grafting (CABG) in HFrEF patients remain underexplored.

Methods: A retrospective multicenter analysis using propensity score matching assessed 574 HFrEF patients who underwent isolated CABG across four academic centers in Germany from 2017 to 2023. Patients were divided into TAR and non-TAR groups, with propensity score matching applied to minimize bias. The primary outcome measured was the incidence of major adverse cardiac and cerebrovascular events (MACCE) with secondary outcomes focusing on hospital stay durations, postoperative complications, and recovery metrics.

Results: The analysis revealed that patients in the TAR group had a significantly lower incidence of major adverse cardiac and cerebrovascular events (MACCE) compared with the non-TAR group (4.1% versus 14.2%, p = 0.007). Postoperative delirium was also significantly reduced in the TAR group (5.0% versus 14.2%, p = 0.016). Although the incidence of mortality tended to be lower in the TAR group (1.7% versus 5.8%), this difference did not reach statistical significance (p = 0.086). Other postoperative complications, such as stroke (1.7% versus 4.2%, p = 0.446), myocardial infarction (3.33% versus 5.0%, p = 0.333), acute kidney injury (13.4% versus 10.9%, p = 0.559), and the need for dialysis (10.0% versus 6.7%, p = 0.484), did not differ significantly between the groups. Similarly, the rates of resuscitation (1.7% versus 2.5%, p = 1.000), resternotomy (1.7% for both groups, p = 1.000), extracorporeal life support (1.7% versus 5.0%, p = 0.181), and sepsis (2.5% versus 5.0%, p = 0.209) were comparable between the TAR and non-TAR groups (see Table 1). These findings highlight the potential benefits of TAR in reducing key adverse events post-CABG in HFrEF patients.

Conclusion: TAR demonstrates a superior advantage in HFrEF patients undergoing CABG, markedly reducing MACCE incidence and enhancing overall postoperative recovery, including shorter ventilation times and decreased incidence of postoperative delirium. The findings underscore TAR’s superiority and suggest a shift toward its broader application in cardiac surgery practices for HFrEF patients, indicating a significant improvement in patient outcomes.

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Artikel online veröffentlicht:
11. Februar 2025